Prevent injury: It's time for a safety check

Tamara Browning

Monday

Apr 27, 2009 at 12:01 AMApr 27, 2009 at 2:42 AM

Outdoor activity from bicycling to organized sports revs up in the spring and summer for youths, and the time-tested lessons on ways to prevent injury hold up. Whether just going for a bike ride or joining a sports team, be sure to take precautions.

Dr. Rodney Herrin taught bicycle safety so well that one day in Florida, his 5-year-old son had to remind the good doctor about it.

“We were down in Florida, and he had his bike, and we went for a bike ride. I forgot to put his helmet on. He said, ‘Dad, you’re going to get arrested.’ He’s learned, ” said Herrin, an orthopedic surgeon with the Orthopaedic Center of Illinois and medical director of Memorial Medical Center’s SportsCare.

“I’m like, ‘What do you mean?’ ‘I forgot to put my helmet on.’ ‘You’re right, buddy. We’ve got to get you home before we get in trouble.’”

Outdoor activity from bicycling to organized sports revs up in the spring and summer for youths, and the time-tested lessons on ways to prevent injury hold up.

“Kids being kids and doing sports, there’s going to be some inherent risks with that, but I think there are things that can be done to decrease that risk,” Herrin said.

Wearing proper protective equipment is among preventative actions that Herrin and Dr. Misty Phillips, a pediatrician with Springfield Pediatric and Adolescent Center, suggest.

Getting a pre-participation sports physical, training before a sports season starts, easing into the activity, avoiding playing through pain and having trained coaches are also ways to help active kids stay safe.

Get a pre-participation sports physical

Injuries are sports-specific, Herrin said.

Knee injuries and fractures occur in football. Ankle sprains and occasional knee problems spring up in basketball. Elbow or shoulder problems crop up with baseball. Wrist and collarbone fractures come with skateboarding and bicycling.

“All kids should be screened to make sure they’re not having chest pain or shortness of breath, symptoms like that where they should have some further workup before playing sports,” Phillips said.

She also said kids can be screened for heart or asthma problems that could limit play time or require medication before play.

“That’s one of the important reasons why schools do require sports physicals.”

Get training before the sport begins

Having kids start training before an athletic season starts can help prevent injuries, Herrin said.

“A lot of times, kids will show up for soccer practice, and they haven’t been doing too much maybe during the winter, and then they get into problems — overuse problems, stress fractures,” Herrin said.

“Studies have shown that if you do that before you start the season, you can decrease the risk of getting an ACL tear, for example,” Herrin said. “If we can prevent an athlete from sustaining an ACL tear, that’s all the better.”

Ease into activity

Proper warm-up before physical activity is important — but it’s often not done, Herrin said.

Specific warm-up movements depend on the sport.

“You start up kind of a light warm-up until you get a little bit of a sweat going. Then that’s when you want to do your stretching, but depending what your sport is, if you’re going to need to do more lower extremity, flexibility or stretching for like track,” Herrin said.

For people who do sports such as track, activity should be increased incrementally.

“The rule of thumb is they call the ‘10 percent rule.’ You should not increase your activity more than 10 percent a week. If you do that faster than that, you’re higher risk of getting a stress fracture or some sort of problem such as that,” Herrin said.

Wear proper equipment

“Protective equipment, depending on the sport, is definitely important. Even in just in bicycling, helmets are very important,” Phillips said.

“Some sports you need mouth guards and knee protective gear and all of that. Just depends on the sport, but definitely wearing the appropriate gear is important.”

“Kids can get very injured without a helmet if they’re in a bicycle crash,” she said.

Avoid playing through pain

If something’s hurting, a young athlete should stop and have the pain evaluated, Phillips said.

“Kids don’t want to stop playing the sport that they’re in. Some of them will keep playing even after they’ve hit their head or they’ve injured their knee,” Phillips said. “They’ll keep playing, and sometimes they can make the injury worse by not stopping and having it evaluated.”

Sprains and strains not treated appropriately or rested can get worse and turn into stress fractures, Phillips said. In the least, a physician should be called at the first sign of trouble.

“But the big thing that kids will do is they just don’t complain much, so they’ll keep going, and then they can make a minor injury a significant injury,” Phillips said.

“That’s where you get into overuse things, especially with baseball with pitching. Kids that are overusing something and then they have a little bit of pain and they kind of ignore it and then it’ll turn into something that is more significant.”

Herrin agreed that children should listen to what their bodies are telling them.

“In the past we’ve said, ‘Don’t play through the pain.’ Well, that should still apply,” Herrin said.

Encourage trained coaches

Memorial’s SportsCare athletic trainers, who specialize in prevention, evaluation and treatment, are at various schools. Soon, athletic trainers are going to be required to have an emergency plan ready to deal with major problems.

The idea is to avoid tragedies similar to the one in which a Kentucky high school football coach was charged with reckless homicide in the death of a player who collapsed during a sweltering practice. Football players should take breaks, drink water and be aware of the weather, Phillips said.

Preparation and education can help prevent situations like what occurred in Kentucky, Herrin said.

“It’s our job as physicians and sports medicine people to help the coaches and to know what’s safe to do, what’s not safe to do and what do you do if you get into a situation where the athlete is at risk. We’re putting programs in place — basically, emergency plans,” said Herrin, whose father, Rich Herrin, is a former Southern Illinois University-Carbondale men’s basketball coach.

Herrin appreciates and respects parents who coach, but “one of the things that decreases the risk of an injury occurring is making certain that that person actually is trained for what they’re doing,” he says.

“For a baseball coach, I think they should a least have a basic understanding of the mechanics of pitching, make certain that the athletes aren’t going to hurt themselves,” Herrin said.

The American Orthopaedic Society for Sports Medicine has recommendations for Little League pitchers. The recommendations include how many pitches they should throw in a game, how much rest they need between games, or at what age, for example, they should begin throwing a curveball or slider (two pitches that confound batters but put strain on a pitcher’s arm because of the way the ball is thrown).

For example, experts recommend waiting to throw a curveball until about age 14, and a slider until about age 16 to avoid pitching injuries to growing athletes.

Phillips, who has a 7-year-old daughter and 3-year-old son who will play soccer, said it’s important for parents to talk with their kids’ coaches. Coaches should be trained in first aid and CPR (cardiopulmonary resuscitation), she said.

Get injuries treated

If all preventative measures fail and a child still gets a sports-related injury, newer treatments can offer quicker recovery.

In the last 10 to 15 years, more minimally invasive (arthroscopic) procedures became available to injured athletes so that they may return to their sports in less time.

“I think the trend is if you do have to have surgery, we’re doing more of an anatomic treatment of the joints whether it’s the shoulder, the knee,” Herrin said. “If a ligament has been injured, we try to replace it back to its previous state as well as we can. In the past, there were some procedures that weren’t exactly anatomic, and they didn’t work as well.”

A groundbreaking procedure first done in the 1970s has been shown to work well, but the popularity of its use is now troublesome.

Known by laymen as the Tommy John procedure, named after a former Los Angeles Dodgers pitcher, doctors replace a ligament in the medial elbow with a tendon from elsewhere in the body.

Known to doctors as ulnar collateral ligament reconstruction, Herrin said the frequency of the procedure indicates young pitchers are probably doing too much — starting at a younger age, being much more intense with their pitching than in the past, and throwing too many pitches.

“I think it’s kind of a warning signal that we’re overdoing it with our young pitchers and probably need to back off because this is something we used to see only in professional or collegiate pitchers. Now we’re seeing it in high school athletes,” Herrin said.

“We want to do things to help decrease the risk of that being a problem. It used to be a rare operation, and now it’s becoming more common, which really isn’t good.”

Get moving

Playing sports is great for kids, Phillips said.

“It helps keep them active and it keeps them from sitting and watching video games and doing stuff like that,” Phillips said. “Sports are great. We just have to be careful like anything else.”

Springfield State Journal Tamara Browning can be reached at tamara.browning@sj-r.com.

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